A better bridge for loop stomas.
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Humans↗
Biomedical subjects
E G Balcos
Publications and source records attributed to E G Balcos.
A comparative study of open, laparoscopic intracorporeal, and laparoscopic assisted low anterior resection and anastomosis in pigs.
This study was done to investigate whether laparoscopic intracorporeal (LI) or laparoscopic assisted (LA) colon resection results in improved anastomotic healing compared with open colon resection (OR). Thirty-six domestic swine were randomly assigned to undergo either LI, LA, or OR of the rectosigmoid. For OR cases, the sigmoid was resected through a midline incision, and a transanal end-to-end stapled anastomosis was constructed with an ILS device. For LA and LI cases, the sigmoid was laparoscopically mobilized and divided distally, using 5 trocar sites. For LA cases, the proximal sigmoid was brought out through an enlarged trocar site and resected; the ILS anvil was secured to the proximal end, and the colon was replaced in the abdominal cavity where the anastomosis was completed by transanal insertion and firing of ILS device. For LI cases, the sigmoid was resected laparoscopically and retrieved through a 33 mm trocar. The ILS anvil was introduced via the same trocar, and the device was laparoscopically secured with two Endoloop (Ethicon Endo-Surgery, Cincinnati, OH) pursestring sutures. The anastomosis was completed the same way as for LA cases. Animals were killed at 7 days, at which time the anastomoses were evaluated by barium enema, bursting pressure, and histologic appearance. There were no radiographic anastomotic leaks. The mean bursting pressure was 205 +/- 65 mmHg for the 13 OR animals, 240 +/- 53 mmHg for 11 LA animals, and 242 +/- 43 mmHg for the 12 LI animals (N.S.). Histologic evaluation for inflammation indicated no significant differences.(ABSTRACT TRUNCATED AT 250 WORDS)
Anastomosis, Surgical↗
Ileal pouch vaginal fistulas: incidence, etiology, and management.
Some of the initial problems associated with the ileoanal reservoir have been solved. In their place, other complications have been recognized. Among these, the ileal pouch vaginal fistula stands out as a recently recognized difficult management problem. This multicenter study was undertaken to gain insight into the causes for, and treatment of, pouch vaginal fistulas. Cases were gathered from 11 surgical practices throughout North America, in which the ileoanal reservoir procedure is frequently performed. Overall, 304 females had undergone ileoanal reservoir procedures by these surgical groups. Twenty-one patients developed 22 pouch vaginal fistulas for an overall incidence of 6.9 percent. Five additional patients with pouch vaginal fistulas, whose restorative proctocolectomies were done elsewhere, were referred to these surgeons for treatment. The courses of these 26 patients form the basis of this report. This study details the risk factors which predispose in the development of a pouch vaginal fistula, as well as the various treatment options available.
Adolescent↗
Is subtotal colectomy a viable option in the management of chronic constipation?
To determine if subtotal colectomy constitutes a valuable alternative in the treatment of patients with chronic constipation, a retrospective review of 52 consecutive patients who underwent subtotal colectomy between January 1980 and August 1985 was undertaken. Forty-six patients underwent ileodistal sigmoidostomy while five patients underwent ileoproctostomy and five with concomitant rectal prolapse underwent simultaneous proctopexy. A mortality rate of 3.8 percent and morbidity rate of 60 percent were encountered. The most frequently occurring complication was small-bowel obstruction, which occurred in 36 percent, and necessitated laparotomy in 66 percent. Additional procedures were necessary in five patients because of newly discovered rectal prolapse (two patients), rectocele (one patient), unrelieved constipation (one patient), and incapacitating incontinence (one patient). Follow-up data available in 94 percent (mean, 46 months) disclosed that patients had an average of 2.8 bowel movements per day without the use of laxatives (89 percent) or enemas (80 percent). Overall, 79 percent were satisfied with the final outcome. It is concluded that subtotal colectomy constitutes a viable option in the treatment of chronic constipation. However, the significant morbidity and mortality associated with the procedure dictate the need for careful patient selection on the basis of appropriate physiologic testing.
Colectomy↗
Recurrence following stapled coloproctostomy for carcinomas of the mid portion of the rectum.
A retrospective analysis of 90 patients who underwent a curative surgical resection for a carcinoma of the middle third of the rectum was carried out to determine the preliminary recurrence rates associated with stapled coloproctostomy. Acknowledging the obvious limitations of this preliminary report, the liberal use of restorative resections for these lesions does not appear to be resulting in an obvious increase in tumor recurrence, and the use of the circular intraliminal staplers has significantly decreased the number of abdominoperineal resections required to treat these lesions. We will continue to use stapled coloproctostomy for the majority of these lesions; however, definitive statements regarding the over-all effect of this approach upon survival time await further studies incorporating larger numbers and longer follow-up studies.
Adult↗
Colocolostomy and coloproctostomy utilizing the circular intraluminal stapling devices.
Coloproctostomy or colocolostomy by peranal insertion of a circular stapling device was performed on 265 patients between January 1978, and June 1981. A low anterior resection was performed in 174 patients. Stapler-related technical complications occurred in 52 patients (20 per cent). Complementary transverse colostomies were performed in 11 patients, of which seven were performed on the first 30 patients. Intraoperative complications occurred in 18 patients (7 per cent). Twenty-six major postoperative complications occurred (10 per cent), and clinical anastomotic leaks occurred in eight patients (3 per cent). Four postoperative deaths occurred (1.5 per cent). This study concludes that (1) coloproctostomy or colocolostomy can be safely performed by transanal insertion of a circular stapling device, (2) these instruments allow a sphincter-preserving procedure to be performed for lesions in the low and midrectum (5 to 10 cm from the anal verge) with an acceptable early morbidity and mortality, and (3) the majority of stapler-related technical complications can be managed without protecting colostomy.
Adenocarcinoma↗
Restorative proctocolectomy with ileal reservoir and ileoanal anastomosis.
An initial experience with a technique of restorative proctocolectomy utilizing a rectal mucosectomy, total colectomy, and ileal reservoir (Parks S-pouch) with ileoanal anastomosis for patients with ulcerative colitis and familial polyposis is presented. Although there were no deaths, significant morbidity did occur and was attributed to the use of a temporary loop ileostomy which may not be necessary. Early functional results are promising and to date, patient satisfaction is very high.
Adolescent↗
A technique for perineal rectosigmoidectomy using autosuture devices.
A perineal rectosigmoidectomy can be performed safely in the elderly poor risk patient with procidentia. An excellent anastomosis can be obtained using an intraluminal stapler or end to end anastomosis autosuture device. This technique can also be used for performing the perineal anastomosis in a colonic pull-through surgical procedure.
Aged↗
Villous adenomas of the rectum: the accuracy of clinical assessment.
To avoid an unnecessary radical operation, it is important for surgeons to identify a clinically benign villous tumor of the rectum, especially in the middle third area, where a transanal approach may not be feasible. If the high accuracy of this clinical impression can be achieved, alternative methods such as piecemeal snare excision, or electrocoagulation, or both are justified. To evaluate the diagnostic accuracy of a benign rectal villous tumor, 151 patients with totally excised rectal tumors were reviewed. All of these patients had soft and nonulcerated lesions and were judged to be benign. Induration and ulceration of the lesions signified malignancy and were excluded. One hundred and fourteen patients (76%) had benign villous adenomas, 23 patients (15%) had superficial carcinomas, and 14 patients (9%) had invasive carcinomas. Hence the accuracy of detecting a clinically benign villous tumor of the rectum was 91%. This is high enough to avoid a more radical procedure when the clinical impression is that of a benign villous tumor of the rectum.
Adenoma↗
How to manage colovesical fistula.
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Colonic Diseases↗
Perianal endometrioma: report of five cases.
One of the gynecologists' commonest findings at pelvic laparotomy is endometriosis. Despite the fact that the presence of endometrial tissue in ectopic locations is commonplace, the finding of a perianal endometrioma is no more than a surgical curiosity. Very few cases have been reported. The present report describes five such verified cases. Interestingly enough, only two of the five cases were diagnosed preoperatively. The pathogenesis of endometriosis has been, and continues to be, controversial. The prevailing theories include 1) transtubal regurgitation of menstrual blood, 2) the coelomic metaplasia doctrine, 3) lymphatic dissemination, and 4) hematogenous spread. Pathologically the lesions may vary grossly from red-blue to yellowish-brown implants, ranging in size from microscopic to 1-2 cm in diameter. The definitive histologic diagnosis requires two of the following three features-glands, stroma, and hemosiderin pigment. The clinical manifestations depend upon the functional activity of the involved tissue and may range from an asymptomatic mass to the classic presentation of a mass increasing in size and becoming acutely painful during menstruation but subsiding in size and decreasing in tenderness between menstrual periods. These protean manifestations are readily illustrated by the cases presented. Anatomically the lesions are usually found in old episiotomy scars. Because these lesions are usually readily accessible, and because their exact nature is frequently not known preoperatively, the treatment of choice is local excision. Complementary hormonal therapy has been suggested, but the value of such treatment is not yet proven. Ovarian ablative therapy is also considered.
Adult↗
Endorectal advancement flap for treatment of simple rectovaginal fistula.
An endorectal advancement flap technique has been utilized in 35 women for repair of "simple" rectovaginal fistulas, i.e., those of low or midseptal location, less than 2.5 cm in diameter, and of traumatic or infectious etiology. Colostomy is unnecessary. Concomitant sphincteroplasty for correction of associated anal incontinence is readily accomplished. Results are excellent with healing ultimately achieved in 32 of 35 women (91 per cent).
Adolescent↗
Sphincteroplasty for acquired anal incontinence.
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Anal Canal↗
Surgical management of large villous tumors of the rectum.
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Aged↗
Abdominoperineal resection for recurrent cancer following anterior resection.
Cases are reviewed of 12 patients who had abdominoperineal resections for cancer recurrence subsequent to anterior resection. Although this procedure is technically more difficult, we experienced no mortality or significant morbidity, and the postoperative hospital stay was similar to that of patients who received an abdominoperineal resection as a primary procedure. Although we have no long-term cures, at least significant palliation can be achieved in selected patients who have no evidence of distant metastases.
Abdomen↗